Individual provider Active NPI

Ria Melinda Travers, PHD

  • Psychologist
  • Peachtree Corners, GA
National Provider Identifier
1336797489
Registry record updated Sep 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY004321 Issued in GA
Practice address
4046 Wetherburn Way Ste 1
Peachtree Corners, GA 30092-4614
Phone
(770) 696-4384
NPI assigned
Sep 2, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 2, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PSY004321 GA
Clinical Child & Adolescent Psychologist 103TC2200X PSY004321 GA
Psychologist 103T00000X PSY004321 GA Primary

Addresses

Primary practice location

4046 Wetherburn Way Ste 1
Peachtree Corners, GA 30092-4614

Mailing address

4046 Wetherburn Way Ste 1
Peachtree Corners, GA 30092-4614
Phone (770) 696-4384

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250221002699 FL Practitioner - Clinical Psychologist 7719407600 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY004321GAMDClinical Child & Adolescent Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Emerald Coast Behavioral Hospital, LLC CurrentSince Dec 23, 2024 Accepting new patients
Georgia Autism Center LLC Clinical PastSince Sep 8, 2019 Accepting new patients

Locations

1940 Harrison Ave
Panama City, FL 32405
Phone (850) 763-0017

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1567382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567382400000",
    "number": "1336797489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4046 WETHERBURN WAY STE 1",
            "city": "PEACHTREE CORNERS",
            "state": "GA",
            "postal_code": "300924614",
            "telephone_number": "770-696-4384"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4046 WETHERBURN WAY STE 1",
            "city": "PEACHTREE CORNERS",
            "state": "GA",
            "postal_code": "300924614",
            "telephone_number": "770-696-4384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAVERS",
        "first_name": "RIA",
        "middle_name": "MELINDA",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-09-02",
        "last_updated": "2019-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "GA",
            "license": "PSY004321",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "GA",
            "license": "PSY004321",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "GA",
            "license": "PSY004321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peachtree Corners, GA

Sources for this page

Verify at the official NPI Registry.